WO2009036982A1 - Agrégat de cellules de type cardiomyocyte issues de cellules hbs - Google Patents

Agrégat de cellules de type cardiomyocyte issues de cellules hbs Download PDF

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WO2009036982A1
WO2009036982A1 PCT/EP2008/007835 EP2008007835W WO2009036982A1 WO 2009036982 A1 WO2009036982 A1 WO 2009036982A1 EP 2008007835 W EP2008007835 W EP 2008007835W WO 2009036982 A1 WO2009036982 A1 WO 2009036982A1
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cells
clusters
cluster
genes
composition
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PCT/EP2008/007835
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Peter Sartipy
Karolina ÅKESSON
Caroline AMÉEN
Jane Synnergren
Kerstin Dahlenborg
Daniella Steel
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Cellartis Ab
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Priority to CA2699860A priority Critical patent/CA2699860A1/fr
Priority to EP08802355.1A priority patent/EP2198012B1/fr
Priority to AU2008300897A priority patent/AU2008300897B2/en
Priority to US12/678,825 priority patent/US20100278787A1/en
Priority to JP2010525254A priority patent/JP5722628B2/ja
Priority to CN200880116644XA priority patent/CN101918541A/zh
Publication of WO2009036982A1 publication Critical patent/WO2009036982A1/fr

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    • C—CHEMISTRY; METALLURGY
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    • C12N5/00—Undifferentiated human, animal or plant cells, e.g. cell lines; Tissues; Cultivation or maintenance thereof; Culture media therefor
    • C12N5/06—Animal cells or tissues; Human cells or tissues
    • C12N5/0602—Vertebrate cells
    • C12N5/0652—Cells of skeletal and connective tissues; Mesenchyme
    • C12N5/0657—Cardiomyocytes; Heart cells
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P9/00—Drugs for disorders of the cardiovascular system
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    • C12N2501/00—Active agents used in cell culture processes, e.g. differentation
    • C12N2501/10—Growth factors
    • C12N2501/115—Basic fibroblast growth factor (bFGF, FGF-2)
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    • C12N2501/00—Active agents used in cell culture processes, e.g. differentation
    • C12N2501/10—Growth factors
    • C12N2501/16—Activin; Inhibin; Mullerian inhibiting substance
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    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
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    • C12N2501/00—Active agents used in cell culture processes, e.g. differentation
    • C12N2501/20—Cytokines; Chemokines
    • C12N2501/23—Interleukins [IL]
    • C12N2501/235—Leukemia inhibitory factor [LIF]
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
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    • C12N2501/00—Active agents used in cell culture processes, e.g. differentation
    • C12N2501/70—Enzymes
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N2501/00—Active agents used in cell culture processes, e.g. differentation
    • C12N2501/999—Small molecules not provided for elsewhere
    • C—CHEMISTRY; METALLURGY
    • C12—BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12N—MICROORGANISMS OR ENZYMES; COMPOSITIONS THEREOF; PROPAGATING, PRESERVING, OR MAINTAINING MICROORGANISMS; MUTATION OR GENETIC ENGINEERING; CULTURE MEDIA
    • C12N2503/00—Use of cells in diagnostics
    • C12N2503/02—Drug screening
    • C—CHEMISTRY; METALLURGY
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    • C12N2506/00—Differentiation of animal cells from one lineage to another; Differentiation of pluripotent cells
    • C12N2506/02—Differentiation of animal cells from one lineage to another; Differentiation of pluripotent cells from embryonic cells

Definitions

  • the present invention relates to novel cardiomyocyte-like cell clusters (CMLC) derived from hBS cells and to the potential use of such cardiomyocyte-like cell clusters in e.g., pharmaceutical drug discovery and development, toxicity testing, cell therapy and medical treatment.
  • the clusters contain cells expressing endodermal, mesodermal as well as cardiac markers.
  • the invention also relates to a method for preparing the cluster, to composition comprising one or more CMLC for use in therapy and toxicity testing.
  • the compositions are stable after storage of the composition at a temperature of at least -80 0 C for at least 2 years, i.e. the characteristics and viability of the clusters are not substantially changed during this storage period.
  • Mature cardiomyocytes are considered terminally differentiated cells and as such they have no, or very low, proliferative capacity.
  • Human cardiomyocytes can be isolated from heart biopsies but the procedure is complicated and it is difficult to obtain viable cell preparations. In addition, the access to human heart tissue is very limited and it is thus not possible to isolate large number of cells. An easy access to cells with a phenotype of human cardiomyocytes is critical for the development of cell therapy interventions for cardiac disease. In addition, due to the lack of donor material as well as the somewhat problematic procedure of cell isolation, human primary cardiomyocytes are not currently available for in vitro testing during pre-clinical drug discovery.
  • pluripotent human stem cells can be isolated from the inner cell mass of blastocysts and these cells have the capacity for indefinite, undifferentiated proliferation in vitro (Thomson et al., 1998; Reubinoff et al., 2000; Heins et al., 2004).
  • Differentiation of human blastocysts derived stem (hBS) cells may occur spontaneously in vitro, especially during, for undifferentiated cells, sub-optimal culture conditions (Thomson et al., 1998; Reubinoff et al., 2000).
  • hBS cells can be coaxed to differentiate in a directed fashion along specific pathways forming a variety of specialized cell types including cardiomyocytes, endothelial cells, neuronal cells, insulin producing ⁇ -cells, and hematopoietic cells (reviewed in: Keller, Genes Dev 2005).
  • cardiomyocytes endothelial cells
  • neuronal cells neuronal cells
  • insulin producing ⁇ -cells insulin producing ⁇ -cells
  • hematopoietic cells reviewed in: Keller, Genes Dev 2005.
  • relatively little is currently known about how to control and manipulate hBS cell differentiation to produce exclusive populations of specific cell types.
  • ⁇ oM ⁇ TTnv roDV For the derivation of cardiomyocytes from hBS cells, in principle two different procedures have been reported. The first is through differentiation of hBS cells initiated when the cells are cultured in suspension and form embryoid bodies (EBs) (Itskovitz-Eldor et al 2000, Kehat et al 2001 ). Within these mixed population of cells contracting areas with functional properties of cardiomyocytes can be observed. The second procedure is based on co-culture of hBS cells with END-2 cells (a visceral endoderm-like cell line) which results in the formation of beating clusters of cells that also display characteristics of cardiomyocytes (Mummery et al 2003, Passier et al 2005).
  • END-2 cells a visceral endoderm-like cell line
  • hBS cell-derived cardiomyocytes During recent years, a number of papers have described, in various ways, the basic characteristics of hBS cell-derived cardiomyocytes. In these reports, cell analysis has been based on the expression of molecular markers for cardiomyocytes, structural architecture, and functionality (reviewed in: Ameen et al 2007 Crit Rev Oncol Hematol). The morphology and ultrastructure of hBS cell-derived cardiomyocytes share similarities with adult cardiomyocytes although the myofibrillar and sarcomeric organization indicate an immature phenotype in the stem cell derived population (Kehat et al 2001 , Snir et al 2003, Norstr ⁇ m et al 2006, Yoon et al 2006).
  • cardiomyocytes On a molecular level, several markers expressed by cardiomyocytes are also expressed by hBS cell-derived cardiomyocytes, including transcription factors, structural proteins, hormones, ion-channels, and tight junction proteins (Kehat et al 2001 , Xu et al 2002, Mummery et al 2003, He et al 2003, Passier et al 2005, Norstr ⁇ m et al 2006, Yoon et al 2006).
  • cardiomyocytes derived from hBS cells show that these cells share similarities with their adult counterparts. More importantly, however, are the functional characteristics of the cells, and different pharmacological and electrophysiological approaches have been used to examine these properties.
  • One major advantage of cardiomyocytes derived from hBS cells is that they can be maintained in culture for extended time periods without loosing their spontaneous contractile capacity. This allows for repeated non-invasive examination of the same cell preparations.
  • hBS cell-derived cardiomyocytes respond to ⁇ / ⁇ -adrenergic- and muscarinic stimuli suggesting that the cells express specific surface membrane receptors coupled to a signalling pathway that activate ion channels, membrane transporters and myofilament proteins (Kehat et al 2001 , Xu et al 2002, Xue et al 2005, Norstr ⁇ m et al 2006).
  • action potentials indicative of nodal-, atrial- and ventricular-like origin have been identified in hBS cell-derived cardiomyocytes using intracellular electrophysiological measurements (Xu et al 2002, Mummery et al 2003, He et al 2003).
  • cardiomyocyte like cell clusters from hBS cells specifically, has a great potential for several of these in vitro applications were they make up a platform for measurements of functional attributes such as action potentials and conduction in cardiomyocytes.
  • the developing clusters may serve as in vitro models to study early events during human cardiogenesis.
  • the clusters may be optimal for use in vivo for restoration of cardiac function after injury or disease.
  • the present invention presents unique cardiomyocyte-like cell clusters derived from hBS cells for use according to the above.
  • the present invention relates to novel cardiomyocyte-like cell clusters (CMLC) and the methods for their preparation from hBS cells.
  • CMLC cardiomyocyte-like cell clusters
  • the CMLC of the present invention are especially well suited for use in drug discovery and toxicity testing.
  • a cluster according to the invention comprises cardiomyocyte-like cells, wherein the cluster has i) contracting cells, ii) cells that are electrically connected, and expresses iii) cardiac markers including Nkx.2.5, troponin and myosin, iv) markers for functional adrenergic receptors, v) markers for functional muscarinic receptors, vi) markers for functional ion-channels including hERG, Na+, Ca2+ and K+ channels, vii) one or more endodermal markers selected from the group consisting of AFP, TF, APOA2,
  • the electrical connection between cells mentioned above may be by gap junctions.
  • said cluster does not express one or more of the following markers for undifferentiated cells: OCT-3/4, SSEA-4, TRA-1-60 as described in example 13.
  • the cluster contains cells that respond to pharmacological stimuli such as beta-adrenergic stimulation (isoproterenol, adrenalin), alpha-adrenergic stimulation (phenylephrine), muscarinic stimulation (carbachol, acetylcholine, atropine), blockage of calcium channels (verapamil), blockage of hERG channels (E4031 ) and inhibition of funny channels.
  • beta-adrenergic stimulation isoproterenol, adrenalin
  • alpha-adrenergic stimulation phenylephrine
  • muscarinic stimulation carbachol, acetylcholine, atropine
  • blockage of calcium channels (verapamil)
  • blockage of hERG channels E4031
  • inhibition of funny channels such as beta-adrenergic stimulation (isoproterenol, adrenalin), alpha-adrenergic stimulation (phenylephrine), muscarinic stimulation (carbachol, acety
  • a cluster according to the present invention comprises cardiomyocyte-like cells and the cluster comprising genes that are up-regulated and have, i) expression values of 500 or more, ii) a fold change in gene expression between cardiomyocyte-like cell clusters and undifferentiated hBS cells (FC CMLC ) of 10 or more.
  • cardiomyocyte-like cells suitable for use in e.g. medical applications, drug screenings and cardiotoxicity studies can be isolated in the form of clusters that are relatively easy to prepare in a reproducible manner and without any need for further differentiation into cardiomyocyte cells.
  • the clusters also contains markers e.g. for endodermal lineage, express one or more ion channels commonly used for cardiotoxicity testing, and express transcription factors.
  • the present invention provides a relative simple means of obtaining a suitable cardiomyocyte-like cell product for medical use as well as for drug screening and testing without the need of purification and complete differentiation to mature cardiomyocytes.
  • the present invention provides a composition that presents the CMLC in a form that is easy to use for the end-user.
  • the composition is prepared by suspending the CMLC in an aqueous medium notably containing agents that ensure the stability of the CMLC during freezing/vitrification, storage, thawing and use of the cluster. Accordingly, the properties of such an aqueous medium must be chosen in consideration of all these four different processes in order to obtain a sole medium that is suitable for the handling of the clusters from the clusters have been prepared and until use of the end-user.
  • the product is presented in fresh or frozen form.
  • blastocyst-derived stem cell is denoted BS cell, and the human form is termed "hBS cells".
  • the pluripotent stem cells used in the present invention can thus be embryonic stem cells prepared from blastocysts, as described in e.g. WO 03/055992 and WO 2007/042225, or be commercially available hBS cells or cell lines.
  • any human pluripotent stem cell can be used in the present invention, including differentiated adult cells which are reprogrammed to pluripotent cells by e.g. the treating adult cells with certain transcription factors, such as OCT4, SOX2, NANOG, and LIN28 as disclosed in Junying Yu, et al., 2007.
  • DMSO dimethylsulfoxide
  • cardiomyocyte-like cells is intended to mean cells sharing features with mature cardiomyocytes. Cardiomyocyte-like cells are further defined by morphological characteristics as well as by specific marker characteristics.
  • CMLC cardiomyocyte-like cells clusters
  • nodal-like cells is intended to mean cells with the following action potential characteristics:
  • MRP Membrane resting potential
  • Atrial-like cells is intended to mean cells with the following action potential characteristics:
  • MRP Membrane resting potential
  • ventricle-like cells are intended to mean cells with the following action potential characteristics:
  • MRP Membrane resting potential
  • expression is used for gene and/or protein expression, whatever must be relevant in the context.
  • cryopreservation denotes the preservation of biological material at an extremely low temperature.
  • mixed differentiated hBS cells is used for a population of spontaneously differentiated hBS cells were cells from all three germ layers mesoderm, endoderm and ectoderm are present. This sample is used as control material to distinguish genes up regulated in many types of differentiated cells from genes specifically up regulated in cardiomyocyte-like cell clusters. In the examples herein is given instructions how to obtain mixed differentiated hBS cells.
  • force aggregation is used for 3D aggregation of cells by an external force, such as centrifugation with a centrifugal force or sedimentation by gravity.
  • feeder cells are intended to mean supporting cell types used alone or in combination.
  • the cell type may further be of human or other species origin.
  • the tissue from which the feeder cells may be derived include embryonic, fetal, neonatal, juvenile or adult tissue, and it further includes tissue derived from skin, including foreskin, umbilical chord, muscle, lung, epithelium, placenta, fallopian tube, glandula, stroma or breast.
  • the feeder cells may be derived from cell types pertaining to the group consisting of human fibroblasts, fibrocytes, myocytes, keratinocytes, endothelial cells and epithelial cells.
  • Examples of specific cell types that may be used for deriving feeder cells include embryonic fibroblasts, extraembryonic endoderm cells, extraembryonic mesoderm cells, fetal fibroblasts and/or fibrocytes, fetal muscle cells, fetal skin cells, fetal lung cells, fetal endothelial cells, fetal epithelial cells, umbilical chord mesenchymal cells, placental fibroblasts and/or fibrocytes, placental endothelial cells,
  • MEF cells is intended to mean mouse embryonic fibroblasts.
  • TGF- ⁇ means transforming growth factor beta, preferably of human and/or recombinant origin.
  • TGF- ⁇ is a protein that comes in three isoforms called TGF- ⁇ 1 , TGF- ⁇ 2 and TGF- ⁇ 3.
  • the TGF- ⁇ family is part of a superfamily of proteins known as the transforming growth factor beta superfamily, which includes inhibins, activin, anti- m ⁇ llerian hormone, bone morphogenetic protein, decapentaplegic and Vg-1.
  • FGF fibroblast growth factor
  • bFGF sometimes also referred to as FGF2
  • FGF4 fibroblast growth factor
  • BMP2 bone-morphogenic protein-2 which is one member of the BMP family of growth factors.
  • xeno-free is intended to mean complete circumvention of direct or in-direct exposure to non-human animal components.
  • Cardiac stem cell marker c-kit and cardiac progenitor markers: lslet-1 , Nkx2.5, GAT A-4. Here regarded as early cardiac markers.
  • cTnl cardiac troponin I and T
  • ⁇ -MHC alpha-myosin- heavy-chain
  • connexin-43 Markers for cardiomyocytes: cTnl, cTnT (cardiac troponin I and T), ⁇ -MHC (alpha-myosin- heavy-chain), connexin-43.
  • a cluster according to the invention comprises cardiomyocyte-like cells, wherein the cluster has i) contracting cells, ii) cells that are electrically connected, and expresses iii) cardiac markers including Nkx.2.5, troponin and myosin, iv) markers for functional adrenergic receptors, v) markers for functional muscarinic receptors, vi) markers for functional ion-channels including hERG, Na+, Ca2+ and K+ channels, vii) one or more endodermal markers selected from the group consisting of AFP, TF, APOA2,
  • a cluster of the invention preferably does not express one or more of the following markers for undifferentiated cells: OCT-3/4, SSEA-4, TRA-1-60. In a specific embodiment the cluster does not express any markers for undifferentiated cells.
  • the present invention provides a cluster comprising cardiomyocyte-like cells, the cluster comprising genes that are up-regulated and have, i) expression values of 500 or more, ii) a fold change in gene expression between cardiomyocyte-like cell clusters and undifferentiated hBS cells (FC CMLC ) of 10 or more.
  • the present invention provides a cluster comprising cardiomyocyte-like cells, the cluster comprising genes that are up-regulated and have, i) expression values of 500 or more, ii) a fold change in gene expression between cardiomyocyte-like cell clusters and undifferentiated hBS cells (FCC MLC ) of 10 or more, and iii) a ratio between FC CMLC and FC M c of 100 or more.
  • FCC MLC undifferentiated hBS cells
  • F MC denoted the fold change for a mixed differentiated hBS cell population.
  • mixed differentiated hBS cells is used for a population of spontaneously differentiated hBS cells where cells from all three germ layers mesoderm, endoderm and ectoderm are present. This sample is used as control material to distinguish genes up- regulated in all types of differentiated cells from genes specifically up-regulated in cardiomyocyte-like cell clusters.
  • the expression values are obtained by measurement with a specific chip (GeneChip® Human Genome U133 Plus 2.0 (Affymetrix Inc., Santa Clara, CA, USA) as detailed described in Example 2 herein. Use of other chips may give different values and therefore any comparison with the values herein should be made using the same kind of chip or a chip giving similar results.
  • a cluster comprising genes which are up-regulated and have, i) expression values of 2000 or more, ii) a FCcM L c value of 100 or more, and iii) a ratio between FC CMLC and FC M c of 100 or more.
  • the clusters are derived from BS cells, notably hBS cells.
  • the starting material may be commercially available BS cells or cell lines or, alternatively, the starting material may be prepared as described in WO 03/055992 and WO 2007/042225.
  • Such material can be obtained from Cellartis AB (www.cellartis.com) and is also available through the NIH stem cell registry (http://stemcells.nih.gov/research/registrv) as well as from the UK Stem Cell Bank (http://www.ukstemcellbank.org.uk).
  • the cluster may fulfill the above- mentioned requirements.
  • the requirements are fulfilled for the cluster and not necessarily for any individual cell.
  • the cells contained in the cluster may be of different degree of differentiation; some may be entirely differentiated into cardiomyocyte-like cells, whereas others may possess characteristics like endodermal cells.
  • the cluster must contain contracting cells.
  • the clusters are typically prepared by subjecting BS, notably hBS, cells to spontaneous differentiation via forced aggregation to obtain 3D-structures containing undifferentiated cells.
  • the cardiomyocyte like cell clusters appear after further cultivation of the 3D-structures for up to 22 days.
  • an objective of the present invention is to provide a cluster containing different types of cells in their development from hBS cells to cardiomyocytes, i.e. from the very beginning of differentiation via intermediate differentiation to fully differentiated cells into cardiomyocytes.
  • a cluster of the invention has a variety of markers.
  • the clusters contain a plurality of cells such as from about 10 to about 5000 cells.
  • a cluster according to the invention contains cells with up- regulated genes (compared to undifferentiated cells), wherein the expression value is about 750 or more such as, e.g., an expression value of about 1000 or more, about 1500 or more, about 2000 or more, about 2500 or more or about 3000 or more.
  • a cluster according to the invention contains cells with up- regulated genes having a FC( CMLC ) value of about 20 or more such as, e.g., about 50 or more, about 100 or more, about 500 or more, about 750 or more, about 1000 or more.
  • the ratio of FC CMLC /FC MC is about 15 or more such as, e.g., about 20 or more, about 50 or more, about 100 or more, about 500 or more, about 750 or more, about 1000 or more.
  • a set of criteria can be set in order to select clusters with different content of up- regulated genes.
  • genes identified in the clusters are genes that are not normally associated with cardiomyocyte-like cells (see the genes marked as "white” in Table II). These findings seem to be of interest and they may play an important role for the functionality of the CMLC with respect to medical use and testing. Specifically cells and tissue of endodermal origin seem to play an essential role in early cardiac development. The CMLC make up a tissue like structure simulating early developing cardiac tissue.
  • a cluster according to the invention has the following characteristics (Table Il and III):
  • the first group consists of genes previously associated with cardiac cells and the second of genes previously associated with endodermal cells, such as hepatocytes.
  • Examples of genes belonging to the first group are (marked in light grey in table II): MYH6, MYL7, MYL4, TNNC1 , TNNT2, PLN, TTN, MYH7, LDB3, NPPB, GATA6, MYL3, CSRP3, ACTN2, MB, MYOZ2, TBX5, and HSP27.
  • genes belonging to the second group are (marked in dark grey in table II): AFP, TF 1 APOA2, AHSG, SERPINA1 , APOA1, ALB, APOC3, TTR, APOB, and RBP4.
  • the selection shows an even distribution between endodermal and mesodermal genes expressed in the clusters.
  • the mesodermal genes and the endodermal are marked in, light grey and dark grey respectively in Table III.
  • a cluster according to the invention has 2 or more such as, e.g., 4 or more, 6 or more, 8 or more, 10 or more, 12 or more or 16 or more of the up- regulated genes are genes associated with cardiac cells, and/or
  • the up-regulated genes are genes associated with endodermal cells, and/or
  • the up-regulated genes are genes associated with non cardiac or non endodermal cells, described in Table Il herein, and/or the up-regulated genes comprise 10 or more such as, e.g., 20 or more, 30 or more, 40 or more, 50 or more, 55 or more or all genes listed in Table Il herein.
  • a cluster comprising genes which are up-regulated and have, i) expression values of 2000 or more, ii) a FCcM L c value of 100 or more, and iii) a ratio between FCC ML C and FC M c of 100 or more.
  • a cluster comprising genes which are up-regulated and have, i) expression values of 2000 or more, ii) a FC CMLC value of 100 or more.
  • the cluster is normally derived from BS cells such as, e.g., hBS cells and the number of cells in the cluster is normally 10 to about 5000 cells or from 10 to about 2000 cells.
  • a cluster according to the invention expresses one or more ion channels.
  • the ion channels identified are ion channels commonly used in cardiotoxicity testing. This is a further indication of the suitability of the CMLC for cardiotoxicity testing.
  • the ion-channel is typically a K-, Na, and/or Ca-ion channel such as a K-voltage-gated channel, a K-inwardly-rectifying channel, a Na-voltage-gated channel, a Na-ligand-gated channel, and/or a Ca-voltage-dependent channel. More specific ion channels are listed in Figure 7 a and b, poster Table 1. In a specific embodiment a cluster expresses at least 3 such as, e.g., at least 4, at least 5 or all of the ion channels listed in Figure 7 a and b, poster Table 1.
  • a cluster according to the invention has all genes listed in any of Table II, III and/or listed in Figure 7 a and b, poster Table 1.
  • the clusters of cardiomyocyte-like cells described above may also be characterized by measuring their transmembrane action potential.
  • the characteristic action potential were recorded and the AP duration at 50%, 70% and 90% of repolarization (dur50 (APD50), dur70 (APD70), dur90 (APD90)), AP amplitude (amp), membrane resting potential (MRP), and maximum rate of rise of the AP upstroke (Vmax) were determined.
  • the clusters were thus characterized as predominately nodal-like, atrial-like, or ventricle-like based on the results of transmembrane action potential (TAP) recordings.
  • TAP transmembrane action potential
  • Cluster, or suspension of clusters were thus found that comprised at least 10%, (such as e.g. at least 13%, at least 15%, or about 17%) of nodal-like cells and/or at least 30% (such as e.g. at least 35%, at least 40%, at least 45 % or about 50% ) of atrial-like cells and/or at least 20% (such as e.g. at least 23%, at least 26%, at least 30%, or about 33%) ventricle-like cells.
  • a cluster according to the invention typically comprises cells expressing one or more such as at least 5, at least 10, at least 15, at least 20, at least 25 or all of the following genes:
  • a cluster of the invention comprises cells expressing one or more such as at least 2, at least 3, at least 4, at least 5 or all of the following genes:
  • a cluster of the invention comprises cells expressing at least 10 such as at least 50, at least 100, at least 200, at least 300 or at least 400 of the markers mentioned in Fig. 11. More specifically, a cluster of the invention comprises cells expression at least 10 such as at least 20, at least 40, at least 60 or all of the following markers:
  • a suspension or composition of cardiomyocyte-like clusters may contain a mixture of clusters containing nodal-like cells, clusters containing atrial-like cells and clusters containing ventricle-like cells.
  • One embodiment the invention thus relates to a suspension or composition of cardiomyocyte-like clusters, wherein the ratio between the number of clusters containing nodal-like cells and the number of clusters containing atrial-like cells is in a range of from about 1 :100 to about 50:100 such as from about 10:100 to about 40:100, from about 20:100 to about 40:100, from about 30:100 to about 40:100 or about 33:100-34:100.
  • the invention in another embodiment relates to a suspension or composition of cardiomyocyte-like clusters, wherein the ratio between the number of clusters containing nodal-like cells and the number of clusters containing ventricle-like cells is in a range of from about 1 :100 to about 80:100 such as from about 10:100 to about 70:100, from about 30:100 to about 70:100, from about 45:100 to about 55:100 or about 50:100.
  • the invention relates to a suspension or composition of cardiomyocyte-like clusters, wherein the ratio between the number of clusters containing ventricle-like cells and the number of clusters containing atrial-like cells is in a range of from about 1 :100 to about 90:100 such as from about 40:100 to about 80:100, from about 50:100 to about 75:100 or about 66:100.
  • the invention relates to a suspension or composition of cardiomyocyte-like clusters, wherein the ratio between the clusters containing nodal-like cells, the clusters containing atrial-like cells and the clusters containing ventricle-like cells is 17:50:33.
  • compositions comprising one or more cluster
  • a cluster-containing composition i.e. one or more clusters of cardiomyocyte-like cells as described above may be in a composition comprising a carrier, such as e.g. an aqueous medium.
  • the composition may further contain one or more additives including one or more cryoprotectants, one or more stabilizers and/or one or more viscosity-adjusting agents.
  • the composition may be in liquid or frozen form.
  • the one or more cryoprotectants may be selected from the group consisting of ethylene glycol, propylene glycol, dimethylsulfoxide, glycerol, propanediol, and methyl pentanediol, and/or mixtures thereof.
  • the additive may also be a sugar or sugar alcohol including sucrose, trehalose, maltose or lactose.
  • the cryoprotectant is trehalose in a concentration from about 0.02 M to about 1 M, such as, e.g., from about 0.05 M to about 0.9 M 1 from about 0.1 M to about 0.8 M, from about 0.15 M to about 0.7 M, from about 0.2 M to about 0.65 M 1 from about 0.25 M to about 0.6 M.
  • concentration of trehalose may preferably be about 0.3 M.
  • the cryoprotectant is sucrose in a concentration from about 0.02 M to about 1 M 1 such as, e.g., from about 0.05 M to about 0.9 M, from about 0.1 M to about 0.8 M, from about 0.15 M to about 0.7 M, from about 0.2 M to about 0.65 M, from about 0.25 M to about 0.6 M.
  • concentration of sucrose may preferably be about 0.3 M.
  • the cryoprotectant may be DMSO in a concentration that is at least 2.5 % v/v, such as e.g. from about 2.5% to about 40% v/v, from about 5% to about 35% v/v, from about 7% to about 30% v/v, from about 7% to about 25% v/v, from about 7% to about 20% v/v, from about 15% to about 25% v/v, or from about 5% to about 15% v/v.
  • the cryoprotectant may be ethylene glycol in a concentration that is at least 2.5 % v/v, such as e.g. from about 2.5% to about 30% v/v, from about 5% to about 25% v/v, from about 5% to about 20% v/v, from about 10% to about 20% v/v, from about 7% to about 10% v/v, or from about 2.5% to about 5% v/v.
  • composition may further comprise a viscosity-adjusting agent selected from the group consisting of Ficoll, Percoll, hyaluronic acid, albumin, polyvinyl pyrrolidone, alginic acid, gelatin and glycerol.
  • a viscosity-adjusting agent selected from the group consisting of Ficoll, Percoll, hyaluronic acid, albumin, polyvinyl pyrrolidone, alginic acid, gelatin and glycerol.
  • the viscosity-adjusting agent may be Ficoll in a concentration at the most about 150 mg/ml, such as, e.g., at the most about 100 mg/ml, at the most about 50 mg/ml, at the most about 25 mg/ml, at the most about 15 mg/ml or at the most about 10 mg/ml.
  • a further component of the composition may be one or more growth factors, e.g. basic fibroblast growth factor (bFGF) in a concentration of about 2 ng/ml, such as about 3 ng/ml, about 4, ng/ml, about 5 ng/ml, about 6 ng/ml or more.
  • bFGF basic fibroblast growth factor
  • composition may also comprise one or more essential and/or non-essential amino acids in appropriate concentrations:
  • essential amino acids are e.g. L-Alanine, L- Arginine, L-Asparagine, L-Aspartic acid, L-Cysteine, L-Glutamic acid, L-Glutamine, Glycine, L-Histidine, L-lsoleucine, L-Leucine, L-Lysine, L-Methionine, L-Phenylalanine, L-Proline, L- Serine, L-Threonine, L-Tryptophan, L-Tyrosine, L-Valine in concentrations raging from about 0.01 mM, such about 0.05 mM, about 0.1 mM, about 0.15 mM, about 0.2 mM or more.
  • the composition may further include one or more inorganic salts such as Calcium chloride (Anhydrous).Cupric sulfate (CuSO4-5H2O), Ferric sulfate (FeSO4-7H2O), Potassium chloride (KCI) 1 Magnesium chloride (Anhydrous), Sodium chloride (NaCI), Sodium bicarbonate (NaHCO3), Sodium phosphate, dibas (Anhydrous), Zinc sulfate (ZnSO4-7H2O), and/or one vitamins, such as Biotin, D-Calcium pantothenate, Choline chloride, Folic acid, i- Inositol, Niacinamide, Pyridoxine hydrochloride, Riboflavin, Thiamine hydrochloride or Vitamin B12.
  • inorganic salts such as Calcium chloride (Anhydrous).Cupric sulfate (CuSO4-5H2O), Ferric sulfate (FeSO4-7H2O),
  • DMEM Dulbecco's Modified Eagle's Medium
  • MEM media MEM media
  • RPMI media RPMI media
  • CMLC CMLC were vitrified in closed straws as described in r WO2004 098285 and stored in liquid N 2 .
  • the cells were recovered after thawing in culture medium (Knock Out DMEM supplemented with 20% FBS, 1 % penicillin-streptomycin, 1% Glutamax, 0.5 mmol/l ⁇ -mercaptoethanol, and 1% nonessential amino acids).
  • the CMLC normally has a size of from about 20 ⁇ m to about 30 ⁇ m. Moreover, 50-80 % of the cells in the cluster express cardiac markers.
  • a suitable product for shipping contains one or more clusters in KnockOut DMEM medium supplemented with 2-20% FBS, 1% penicillin-streptomycin, 1% Glutamax, 0.5 mmol/l ⁇ - mercaptoethanol and 1 % non-essential amino acids (all from Invitrogen, Carlsbad, California).
  • a composition according to the present invention provides a composition wherein the cluster retains at least 95% of its described characteristics after storage at a temperature of at least - 80 0 C for at least 2 years. Further, at least about 50% or more such as, e.g., about 55% or more, about 60% or more, about 65% or more, about 70% or more, about 75% or more, about 80% or more, about 85% or more, about 90% or more or about 95% or more of the cells are viable after storage of the composition at a temperature of at least -80 0 C for at least 2 years.
  • Kit The present invention further provides a kit for use in testing of cardiotoxicity of a specific substance, wherein the kit comprising i) one or more cluster of cardiomyocyte-like cells or a composition as described above, and ii) specific instructions for use of the cluster or composition, whichever is relevant.
  • the kit may comprise a composition of cardiomyocyte-like clusters of nodal-like cells and/or atrial-like cells and/or ventricle-like cells as defined above.
  • the kit may further comprise iii) a medium into which the specific substance is dispersed before use of the kit.
  • the present invention provides a kit for use in in vitro testing during drug discovery of a specific substance, wherein the kit comprises i) one or more clusters of cardiomyocyte-like cells or a composition as described above, ii) specific instructions for use of the cluster or composition, whichever is relevant.
  • the kit may comprise a composition of cardiomyocyte-like clusters of nodal-like cells and/or atrial-like cells and/or ventricle-like cells as defined above.
  • the kit may further comprise iii) a medium into which the specific substance is dispersed before use of the kit.
  • the present invention also provides a kit for regenerative medicine comprising i) a composition and/or one or more cardiomyocyte-like cell clusters as described above, and ii) tools for administration of the composition or the cells to a patient such as, e.g., the cells in an administrative form, such as in a ready-to-use syringe.
  • the kit may comprise a composition of cardiomyocyte-like clusters of nodal-like cells and/or atrial-like cells and/or ventricle-like cells as defined above.
  • the cryopreservation of the cardiomyocyte-like cell clusters may be performed by using a slow freezing method or by vitrification, using open or closed pulled straws.
  • Vitrification solutions At least one of the vitrification solutions (the first and the second solution) may contain one or more cryoprotectants or mixtures of cryoprotectants.
  • Non-toxic cryoprotectants are of course preferable.
  • Cryoprotectants help minimizing shrinking by reducing the mole fraction of other solutes remaining in the non-frozen water. They inhibit the formation of crystalline ice, and thus depress the freezing point of the water. They may also prevent protein denaturation by hydrogen binding with bound water. As cells cool, solvent water converts to extracellular ice, and the increasing extracellular concentration of non-permeating electrolyte or non- electrolytes damages the cells. When treated with a cryoprotectant, cells do not reach the salt concentrations of non-treated cells until they reach much lower temperatures.
  • cryoprotectants may also function as osmotically active agents.
  • Suitable cryoprotectants can be selected from the group consisting of ethylene glycol, propylene glycol, dimethylsulfoxide, glycerol, propanediol, sugars including sucrose, trehalose, maltose, lactose and methyl pentanediol.
  • a vitrification procedure may comprise the following steps, i) transfer of the cardiomyocyte-like clusters to a first solution, ii) optionally incubation of cardiomyocyte-like clusters in the first solution, iii) transfer the cardiomyocyte-like clusters obtained in step i) or ii) to a second solution, iv) optionally incubation of the cardiomyocyte-like clusters in the second solution, v) transfer of the cells obtained from step iii) or iv) into one or more, open, closed at least on one side or fully closed straws, and vi) vitrification of the one or more open, closed at least on one side, or fully closed straws.
  • the concentration of the individual agents contained in the first and or the second solution is normally in a range of 5-50% v/v such as, e.g. from about 5% to about 40% v/v such as e.g. from about 5% to about 25% v/v (first solution) and from about 5% to about 30% v/v (second solution).
  • the total concentration (i.e. calculated as v/v, w/v or M) of the cryoprotectant in the second solution is larger than that in the first solution.
  • the first and the second solution may contain one or more cryoprotectants that are the same or different.
  • the concentration of the one or more cryoprotectants in the first and the second solution can be the same or different, and normally the total concentration of the cryoprotectant in the second solution is larger than that in the first solution.
  • the cryoprotectant is trehalose.
  • concentration of trehalose contained in the first and/or the second solution is normally within a range from about 0.02 M to about 1 M, such as, e.g., from about 0.05 M to about 0.9 M, from about 0.1 M to about 0.8 M 1 from about 0.2 M to about 0.7 M, from about 0.3 M to about 0.65 M, from about 0.4 M to about 0.6 M, from about 0.45 M to about 0.55 M.
  • sucrose is used in similar applications.
  • Trehalose is a unique, naturally occurring disaccharide and is found in hundreds of plants and animals.
  • Trehalose is an important source of energy and has been shown to be a primary factor in stabilization of organisms during time of freezing. It has been shown that trehalose can depress the phase transition temperature of membranes so that they remain in the liquid-crystal state even when dry. Without being bound to any theory, it is hypothesized that this prevents membrane leakage during rehydration, thereby preserving cellular viability. With respect to proteins, trehalose has been shown to inhibit protein denaturation by exclusion of water from the protein surface when the cells are in the hydrated state.
  • the cryoprotectant is sucrose.
  • concentration of sucrose contained in the first and/or the second solution is normally within a range from about 0.02 M to about 1 M, such as, e.g., from about 0.05 M to about 0.9 M, from about 0.1 M to about 0.8 M, from about 0.2 M to about 0.7 M, from about 0.3 M to about 0.65 M, from about 0.4 M to about 0.6 M, from about 0.45 M to about 0.55 M.
  • At least one of the first and second solutions comprises a cryoprotectant.
  • At least one of the first and the second solution may comprise a viscosity-adjusting agent.
  • Suitable viscosity-adjusting agent for use in the present context may be selected from the group consisting of Ficoll, Percoll, hyaluronic acid, albumin, polyvinyl pyrrolidone, alginic acid, gelatin and glycerol.
  • the first and the second solution may contain one or more viscosity-adjusting agents that are the same or different.
  • the concentration of the one or more viscosity-adjusting agents in the first and the second solution may be the same or different.
  • the viscosity-adjusting agent is Ficoll.
  • the concentration of Ficoll contained in the first and/or the second solution is at the most about 150 mg/ml, such as, e.g., at the most about 100 mg/ml, at the most about 50 mg/ml, at the most about 25 mg/ml, at the most about 15 mg/ml or at the most about 10 mg/ml.
  • At least one of the first and second solutions is an aqueous solution.
  • xenofree hBS cell lines and culture methods are applied for therapeutic applications of the cardiomyocyte-like cell clusters.
  • the hBS cell line constitutes a trisomic cell line such as SA002 carrying an extra chromosome 13.
  • This cell line has shown a great tendency for efficient development into cardiomyocyte like cell clusters, as well as a high yield of clusters.
  • One advantage of developing CMLC using hBS line SA002 is that the cells carry an intrinsic "label" (i.e., three copies of chromosome 13) which can be readily detected (using standard genomic techniques) in mixtures of non-trisomic cells derived or isolated from other sources.
  • Another aspect the present invention relates to a method for preparing CMLCs from hBS cells.
  • the novel method has shown to be advantageous compared with prior art method using EB formation as the yield of beating clusters are markedly improved.
  • the new method is also more suitable for large scale production.
  • the cell lines used in this method may be obtained from a commercial available cell line, such as e.g. SA 002, SA 121 , SA 001 , SA002.5, and SA 461 , available from Cellartis AB, G ⁇ teborg, Sweden.
  • the present invention provides a method for the preparation of a cluster comprising cardiomyocyte-like cells, the method comprising the steps of: i) suspending and dissociating undifferentiated hBS cells in a culture medium, ii) subjecting the thus dissociated aggregates to forced aggregation, iv) incubating the thus forced aggregated cell aggregates in culture medium optionally comprising one of more growth factors to obtain one or more 3D structures, v) transferring one or more 3D structures to one or more plates and incubating the 3D structures in culture medium optionally comprising one or more growth factors to develop them into one or more clusters comprising contracting cells.
  • the method may also comprise a further step of isolating the one or more clusters by removing the one or more clusters from said plate.
  • the method for obtaining cardiomyocyte-like clusters comprises the steps of
  • the cells may be detached from the feeder layer by use of mechanical or, preferably, enzymatic treatment, whereby a suspension of primarily undifferentiated hBS cells is obtained.
  • the enzymatic treatment may be performed by use of a proteolytic enzyme, such as a collagenase, for an appropriate time, e.g. 2-20 minutes, 5-15 minutes or 10-15 minutes.
  • a proteolytic enzyme such as a collagenase
  • the cells obtained in the above-mentioned step 1 are mainly undifferentiated, meaning that from about 70% or more, such as e.g. 80 % or more, 85% or more, 90 % or more, 95% or more, or 99% or more of the cells are undifferentiated.
  • the cell suspension may thereafter be resuspended in an appropriate media which supports the cells, this media can for example be Knock Out DMEM supplemented with FBS (preferably in the range 15-25%, such as 20%).
  • the culture medium can, at various time points during the experiments, be supplemented with different factors such as protein growth factors, chemical compounds, minerals, or other signalling molecules. Examples of such factors are BMP-2, BMP-4, BMP-5, TGF- ⁇ 1 , Activin A, Growth hormone, LIF, and PDGF. It is important to note that the suspension step is relatively short and does not allow for embryoid bodies to develop. In the present method the suspension step is just a transfer step.
  • the resuspended cells may thereafter be further dissociated into small aggregates of undifferentiated cells, in the event that the cells form large aggregates (e.g. above 0.5 mm).
  • This dissociation can be performed manually, e.g. by using a pipette, until the cells forms small aggregates of the size 0.2-0.4 mm.
  • the culture dish(es) used may be of any kind that supports the cells, but in a preferred embodiment the culture dish(es) are gelatine coated dishes.
  • the cell aggregates obtained in step 2) or 3) are subjected to forced aggregation and/or sedimentation before transferring the cells to the culture dish(es) in step 4) and 5).
  • 3D structures are formed when spun down through forced aggregation.
  • the 3D structures are different from embryoid bodies.
  • the advantage is that a more reliant structure is formed when compared to e.g. embryoid bodies, which have a tendency to fall apart, and therefore the present method gives a higher yield between the number of undifferentiated cells used and the resulting number of cardiomyocyte-like clusters.
  • the method is also advantageous in that it is faster, more reliable and more scalable and useable for automation compared to the prior art EB protocols.
  • the preferred method for obtaining cardiomyocyte-like clusters comprises the steps of
  • step 4 optionally, centrifuge and/or sediment the cells obtained in step 1 or 2,
  • step 2 By using forced aggregation approximately 4-6 colonies from step 2) or 3) are transferred to a plate or tube appropriate for centrifugation, e.g. a 96-well v-bottom plate (Corning Incoporated, NY, USA). The cells are then centrifuged for 2-20 minutes at 100-800 x g (e.g. 200-600 x g for 5-10 min or, 300-500 x g for 5-10 min, or at 400 x g for 5 min.). These centrifuged cells may, before the transfer mentioned step 6), further be incubated for 1-10 days (such as 1-7 days, or 1-5 days) for the formation of 3D structures, which structures then are transferred according to step 6) above.
  • a plate or tube appropriate for centrifugation e.g. a 96-well v-bottom plate (Corning Incoporated, NY, USA).
  • the cells are then centrifuged for 2-20 minutes at 100-800 x g (e.g. 200-600
  • the forced aggregation may additionally be combined, or replaced, by sedimentation of the cell suspension obtained step 2) or 3), for 1-36 hours (such as 2-24 hours or 3-12 hours), before proceeding to step 6).
  • the yield of CMLC from hBS cells can be further improved by supplementing the culture medium used with different factors such as protein growth factors, chemical compounds, minerals, or other signalling molecules.
  • the culture medium e.g. DMEM
  • step 5 and/or step 7 of the preferred method increases.
  • This yield as shown in figure 6, and in example 9, increases a 4.7 fold compared to controls grown in the same media, but without bFGF or Activin A added.
  • the concentrations of Activin A supplemented to the culture medium comprises from about 5-40 ng/ml, such as e.g. 8 ng/ml, 9 ng/ml, 10 ng/ml, 11 ng/ml, or 12 ng/ml; and the concentration of bFGF supplemented to the culture medium comprises from about 5-40 ng/ml, such as e.g. 10 ng/ml, 11 ng/ml, 12 ng/ml, 13 ng/ml or 14 ng/ml.
  • the method for obtaining cardiomyocyte-like clusters thus comprises the steps of
  • the invention may also take place by sedimenting the cells instead of centrifugation.
  • Specific embodiments of the invention thus comprises,
  • the yield have also been shown to increase (as shown in e.g. figure 15) when the medium used in step 5 and/or 7 of the preferred method is further supplemented (either alone or in combination with Activin A 1 bFGF and/or FBS) with a member of GSK-3 inhibitors and/or p38 MAP kinase inhibitors such as SB 216763 and SKF-860002, respectively.
  • the yield increased by 2-3 fold when Activin A, bFGF and SB 216763 or SKF-860002 are added to the culture medium in step 5 of the preferred method compared to controls where only Activin A and bFGF are added .
  • This medium may be supplemented at any stage of the method, however in one embodiment the medium is supplemented to the cells during their incubation after the centrifugation in step 5) of the preferred method.
  • the concentration of the GSK-3 inhibitor supplemented to the culture medium may be in the range of from about 1-25 ⁇ M, such as e.g. 2-10 ⁇ M or 5 ⁇ M, and the concentration of the p38 MAP-kinase inhibitor supplemented to the culture medium may be in the range of about 1-25 ⁇ M, such as e.g. 2-10 ⁇ M or 5 ⁇ M.
  • the inventors have also shown that by supplementing the medium in step 7 of the preferred method (or the corresponding step 5 of the first mentioned embodiment of the method) containing Activin A and/or bFGF with LIF 1 the yield improved by approximately a 2 fold compared to controls that only receive medium, as shown in e.g. figure 14 and example 10.
  • the concentration for LIF comprises between 100-2000 U/ml LIF, such as e.g. between 500- 1500 U/ml, or 1000 U/ml.
  • the medium comprising LIF is replaced after 2-8 days, such as after e.g. 4-5 days, with a medium without LIF during the development of cardiomyocyte-like cell clusters in step 7) of the preferred method (or the corresponding step 5 of the first mentioned embodiment of the method).
  • a cluster according to the invention can be used in in vitro studies (e.g. in drug discovery, drug testing, target identification and target validation, e.g. based on electrophysiological measurement on funny channels as described Examples 11 and 14.
  • FIG. 1 Morphological illustration of CMLC derived from hBS cells. Undifferentiated hBS cells were maintained and differentiated as described in Example 1. The 3D structures were subsequently plated in gelatine coated cell culture dishes leading to attachment and further differentiation of the cells. Panel A shows a 3D cluster 1 day after plating in a culture dish. Panel B shows a spontaneously beating area present in the outgrowth of a 3D structure 3 days after plating (circle). Panel C shows a mechanically isolated beating area sub-cultured for 12 days after isolation in a new culture dish.
  • FIG. 1 Morphological illustration of CMLC that has been stained to show nuclei (round objects) and cardiac troponini (line like structures) (magnification x 600).
  • the CMLC were derived as described in example 1.
  • FIG. 1 Distribution in beating frequency of CMLC.
  • CMLC were differentiated from hBS cells as described in Example 1 , and 109 different spontaneously contracting clusters were evaluated.
  • the figure shows the distribution in beating frequency in the cell preparations.
  • CMLC complementary metal-oxide-semiconductor
  • CMLC complementary metal-oxide-semiconductor
  • Two different developmental stages of CMLC were prepared; early CMLC (maintained for up to two weeks in culture) and late CMLC (maintained for at least 6 weeks in culture).
  • TaqMan® low density arrays (384-WeII Micro Fluidic Cards, Applied Biosystems) were used.
  • commercially available total RNA from human adult normal heart tissue (pool from 6 different male donors) (BioChain®) was analyzed in parallel.
  • QPCR was performed as described in Example 3.
  • Panel A shows the RNA levels for POU5F1 (Oct-4), NANOG, NKX2.5, GATA4, TNNI3, DES 1 SCN5A, and SCN1 B.
  • Panel B shows the gene expression levels for SCN2B, CACNA1C, CACNB1 , CACNB2, CACNA2D1 , CACNA1 H, KCNQ1 , and KCNE1.
  • Panel C shows the gene expression levels for KCNH2, KCNE2, KCNA5, KCNAB1 , KCNAB2, KCNJ2, KCNJ12, and KCNJ3.
  • Panel D shows the gene expression levels for KCNJ5, KCNJ11 , ABCC9, KCND3, KCNA4, Kcnip2, HCN4, and KCNK1.
  • Panel E shows the gene expression levels for CFTR, GJA5, GJA1 , GJA7, ATP2A2, SLC8A1 , RYR2, and FKBP1 B.
  • Panel F shows the gene expression levels for SLC9A1 , MYL2, MYLK 1 MYH6, and MYH7.
  • Figure 5 Shows cumulative dose response curves upon increasing drug concentrations (0, 10OpM, 1nM, 1OnM, 10OnM, 100OnM) measured as a delayed repolarisation of the cardiac field potentials after the addition of Astemizol (antihistaminic) and Dofetilide (a class III anti arrhythmic drug).
  • Astemizol antihistaminic
  • Dofetilide a class III anti arrhythmic drug
  • Figure 5a Astemizol caused a selective block and sustained prolongation of the repolarizing component at low nanomolar concentrations. Similar effects were observed using Dofetilide (Figure 5b).
  • Figure 5c shows the dose dependent effect of Terfenadine on the field action potential duration
  • Figure 5d shows the effect of the potassium channel blocker Cisapride which causes a dose dependent prolongation of the action potential.
  • CMLC were derived from undifferentiated hBS cells (SA002) as described in example 1.
  • Activin A (10 ng/ml)
  • bFGF (12 ng/ml)
  • the controls received medium with no factors added.
  • Post- plating medium with 20% FBS but without factors was used for both groups.
  • Data were normalized to an endogenous control and are expressed as relative gene expression with the control set to 100 %. The data shown are the mean of gene expression of the respective gene in two experiments; A) Nxk2.5, B) GAT A4, C) Troponin T2 and D) alpha-cardiac actin.
  • Panel E shows the mean value of the number of beating CMLC generated in three experiments.
  • FIG. 8 Overrepresented Gene Ontology annotations: Significantly overrepresented Gene Ontology annotations among the 530 up-regulated genes, in hBSC-derived CMCLs. Only significantly overrepresented annotations (p ⁇ 0.01) are shown in the picture. Panel A represents "Biological process”, panel B "Molecular function” and panel C "Cellular component”. The X-axis shows the number of genes with a specific annotation.
  • Panel A shows the interaction map of the gene products from 530 significantly up-regulated genes in hBSC-derived CMCLs and panel B shows a corresponding interaction map for one of the randomly generated sets of proteins.
  • Hub protein network in hBSC-derived CMCLs Proteins are identified as hubs if they have at least five experimentally determined protein interactions among the products of the up-regulated genes.
  • FIG 11. A complete list of the 530 genes that were significantly up-regulated in CMCLs compared to undifferentiated hBSs, identified using the SAM algorithm.
  • "Avg FC" column shows the average fold change between the two experiments and next column to the right shows the range of the calculated fold changes across the different samples. The rightmost column represents different categories regarding how these genes have previously been reported to be expressed in heart tissue.
  • 331 had been reported as expressed in heart before.
  • the genes that have not been reported as expressed in heart or lack a tissue expression record in WebGestalt are marked with X (86 genes).
  • Genes that are reported as significantly over- expressed are marked with O (100 genes) and significantly under-expressed genes are marked with U (25 genes).
  • Genes marked with N (206 genes) are reported as expressed in heart but with no significance in expression.
  • Genes marked with dash (-), in total 113 genes represent genes that were significantly up-regulated in CMLC by the WebGestalt toolbox.
  • FIG. 12 Genes that are significantly down-regulated in hBSC-derived CMCLs compared to undifferentiated hBSCs. Among these 40 genes are well known markers for pluripotency, such as NANOG, POU5F1 , SOX2, TDGF1, DPPA4, LEFTY1 , and DNMT3B.
  • Figure 13 CMLC were derived from undifferentiated hBS cells (SA002) as described in example 1. During 3D formation (pre-plating) different types of FBS was supplemented to the medium (20%) as indicated in the graph. The controls received standard FBS and this was compared to dialyzed and charcoal stripped FBS.
  • CMLC were derived from undifferentiated hBS cells (SA002) as described in Example 1. During 3D formation (pre-plating) the culture medium was supplemented with Activin A and bFGF (F). The controls (C) received standard medium only. Post-plating, some groups received medium supplemented with 1000U/ml LIF (F+LIF) while the others received standard medium alone. Four days post-plating all groups received standard medium. The number of beating CMLC was counted at day 7 and day 14 post-plating using a light microscope and compared to the control. The data shown are the mean of the number of beating CMLC generated in three experiments relative to the control set to 1. The error bars indicate the S.D.
  • FIG. 15 Effect of SB 216763 and SKF-86002 on the yield of beating CMLC.
  • CMLC were derived from undifferentiated hBS cells (SA002) as described in Example 9.
  • SB 216763 5 ⁇ M
  • SKF-86002 5 ⁇ M
  • the control received medium with only Activin A and bFGF added.
  • Post-plating standard medium without factors was used for all groups.
  • the graph shows the collective number of beating areas related to the number of hBS cell colonies used in the experiments.
  • AF Activin A + bFGF
  • SB SB 216763
  • SKF SKF-86002.
  • FIG. 16 The day at which 3D-aggregat.es of differentiated hBS cells are transferred from the 96-well plates to new culture dishes significantly affects the number of beating CMLC that can be generated.
  • CMLC were derived from undifferentiated hBS cells (SA002) as described in Example 1. More CMLC are produced from the 3D-aggregates that are transferred earlier when compared to transfer at 7 days.
  • SA002 undifferentiated hBS cells
  • More CMLC are produced from the 3D-aggregates that are transferred earlier when compared to transfer at 7 days.
  • the data shown are the mean of the number of beating CMLC generated relative to the control (7 days) set to 100 at different plating days (5, 4 ,and 3).
  • the error bars indicate the S.D.
  • Figure 17 Through microelectrode recordings three different types of action potential morphologies were demonstrated; ventricle-like, atrial-like, and nodal-like.
  • Figure 18. Example of ventricular-like AP with an amplitude of 97 mV and long APD90 of 342 ms.
  • FIG. 19 Each CMLC cluster was characterized by a predominant AP morphology.
  • the graph illustrates APD90 in 16 different clusters and they show similar values for repeated impalements within the same cluster.
  • FIG. 20 Rate adaptation of CMLC clusters during exposure to field stimulation of 1 , 2, and 3 Hz.
  • Left panel Plot showing that clusters with an initial APD90 over 180 ms showed rate adaptation as pacing frequency increased.
  • Right panel Overlay plot of AP at 1 , 2, and 3 Hz pacing.
  • Figure 21 Through microelectrode recordings action potential measurements were preformed during incubation of CMLC clusters with Zatebradine. Right figure shows an overlay plot.
  • FIG. 22 Effect of IKr block (E-4031 ) on APs.
  • Administration of E-4031 caused APD prolongation, triangulation, and EADs in CMLC clusters.
  • FIG. 23 Effect of IKr block on APs.
  • Top left panel Administration of E-4031 caused prolonged APD in all cases and clear signs of triangulation as seen on the shape of APs and a greater lengthening of APD90 compared to APD50.
  • Top right panel In a majority of cases, APD prolongation was followed by triggered activity.
  • Bottom panel Early after depolarizations (EADs) were also recorded.
  • FIG. 24 Effect of Activin A, bFGF, SB 216763 and SKF-86002 on the yield of beating.
  • CMLC CMLC were derived from undifferentiated hBS cells (SA002) as described in Example 1. During 3D formation (pre-plating), different concentrations of Activin A, bFGF, SB 216763 and SKF-86002 were supplemented to the medium in addition. Post-plating, medium without factors was used for all groups. The picture shows the collective number of beating areas related to the number of colonies used in one dish per group. The experiment was repeated three times.
  • AF Activin A + bFGF
  • SB SB 216763
  • SKF SKF-86002.
  • FIG. 25 No Oct-3/4 hBS cell marker expression in hBSC derived CMLC. lmmunohistochemical examination of stem cell marker Oct-3/4 expression in growing hBS cell colonies (A-B) and in hBS cell derived CMLC (C-H).
  • A-B Nuclei are stained blue with 4 ' ,6- diaminidine-2-phenylidole dihydrochloride (DAPI).
  • B hBS cell colony showing positive staining with antibody against Oct-3/4 (green). Sections from at least ten CMLC (only three are shown here) were labeled with antibodies against cardiac Troponin I (cTnl; red) and Oct- 3/4 (green), as well as with DAPI for the nuclei (blue).
  • the left panel (C, E and G) shows overlay of cTnl (red) and DAPI (blue) staining
  • the right panel (D 1 F and H) shows overlay of Oct-3/4 (green) and DAPI (blue) staining. While all CMLC showed positive staining with cTnl (C, E and G) no detectable staining of the Oct-3/4 hBS cell marker could be observed in the clusters (D, F and H). Scale bars: 100 ⁇ m.
  • FIG. 26 No SSEA-4 hBS cell marker expression in hBS cell derived CMLC. lmmunohistochemical examination of stem cell marker SSEA-4 expression in growing hBS cell colonies (A-B) and in hBS cell derived CMLC (C-H).
  • A-B Nuclei are stained blue with 4 ' , 6- diaminidine-2-phenylidole dihydrochloride (DAPI).
  • B hBS cell colony showing positive staining with antibody against SSEA-4 (green). Sections for at least ten CMLC (only three are shown here) were labeled with antibodies against cardiac Troponin I (cTnl; red) and SSEA-4 (green), as well as with DAPI for the nuclei (blue).
  • the left panel (C, E and G) shows overlay of cTnl (red) and DAPI (blue) staining
  • the right panel (D, F and H) shows overlay of SSEA-4 (green) and DAPI (blue) staining. While all CMLC clusters showed positive staining with cTnl (C, E and G) no detectable staining of the SSEA-4 hBSC cell marker could be observed in the clusters (D, F and H). Scale bars: 50 ⁇ m.
  • FIG. 27 No TRA-1-60 hBS cell marker expression in hBS cell derived CMLC. lmmunohistochemical examination of stem cell marker TRA-1-60 expression in growing hBS cell colonies (A-B) and in hBS cell derived CMLC (C-H).
  • A-B Nuclei are stained blue with 4 ' , 6- diaminidine-2-phenylidole dihydrochloride (DAPI).
  • B hBS cell colony showing positive staining with antibody against SSEA-4 (green). Sections for at least ten CMLC (only three are shown here) were labeled with antibodies against cardiac Troponin I (cTnl; red) and TRA-1-60 (green), as well as with DAPI for the nuclei (blue).
  • the left panel (C 1 E and G) shows overlay of cTnl (red) and DAPI (blue) staining
  • the right panel (D, F and H) shows overlay of TRA-1-60 (green) and DAPI (blue) staining. While all CMLC showed positive staining with cTnl (C, E and G) no detectable staining of the SSEA-4 hBS cell marker could be observed in the clusters (D, F and H). Scale bars: 100 ⁇ m.
  • Figure 28 The effect of Zatebradine on the beating frequency of contracting CMLC derived from hBS cells.
  • FIG. 29 lmmunohistochemical analysis of CMLC derived from hBS cells.
  • the figure shows positive staining for antibodies against the hERG ion channel (KCNH2) (panel A), nuclei (DAPI) (panel B), and cardiac troponin I (panel C). Scale bar, 50 ⁇ M.
  • FIG. 30 Micro electrode array (MEA) analysis of hES cell derived cardiomyocytes.
  • Panel A shows a hES cell derived cardiomyocyte cluster (hES-CMCTM, Cellartis AB) cultured directly on to a MEA (Multichannel Systems, Germany).
  • the MEA technology allows multiple field potential waveforms to be recorded simultaneously, allowing for the analysis of wave propagation and conduction velocity (Panel B).
  • Panel C shows cumulative dose response curves, upon increasing drug concentrations (0, 1 nM, 1OnM, 10OnM, 1 ⁇ M, 10 ⁇ M), after the addition of Astemizol (an antihistaminic with know QT-prolongation effects).
  • Astemizol an antihistaminic with know QT-prolongation effects
  • Example 1 Differentiation of hBS cells to cardiomyocyte-like cell clusters
  • Spontaneously contracting cells were derived from undifferentiated hBS cells cultured on MEF cells (Heins et al 2004 Stem Cells).
  • the cell lines used for this experiment could be the hBS cell line SA002, SA121 , SA001 , SA002.5, SA461 (Cellartis AB, G ⁇ teborg, Sweden, http://www.cellartis.com) and they can be propagated as described Heins et al. 2004. These cell lines are listed in the NIH stem cell registry and the UK Stem Cell bank.
  • the hBS cells were detached from the feeder layer by incubation with collagenase IV (200 U/ml), for 10 - 15 minutes at 37 0 C.
  • the cell suspension was transferred to a 15 ml tube, and after the cells had sedimented, the supernatant was removed.
  • the colonies were resuspended in Knock Out DMEM supplemented with 20% FBS 1 1 % penicillin-streptomycin, 1% Glutamax, 0.5 mmol/l ⁇ -mercaptoethanol and 1 % non-essential amino acids (all from Invitrogen, Carlsbad, California) and dissociated mechanically into small aggregates of undifferentiated cells (0.2 - 0.4 mm) using a pipette.
  • This cell suspension was distributed (200 ⁇ l/well) into a 96-well v- bottom plate (Corning Incorporated, NY, USA) at a concentration of approximately 4 - 6 colonies per well and centrifuged for 5 min at 400 x g. The plate was then incubated at 37 0 C for 3 - 8 days. The 3D structures that formed were then transferred to gelatine coated dishes containing culture medium (same as above). After a couple of days (normally 1-4) of culture, spontaneously contracting areas with cluster of contracting cells (CMLC) occurred and could be visually identified using a light microscope. Medium was changed every second to third day. New spontaneously beating areas continued to appear for up to 20 days post-plating.
  • CMLC cluster of contracting cells
  • FIG. 1 a, b and c shows representative illustrations of the appearance of the CMLC derived from hBS cells.
  • hBS derived CMLC were differentiated as described above. These were then manually isolated from the surrounding cells and plated onto laminin coated glass. After three days in culture, the clusters were fixed and stained for nuclei and the protein cardiac troponin 1 , which is known to be specific for cardiac tissue. These clusters were then examined with confocal microscopy.
  • the micrograph in figure 2 shows a CMLC that has been stained to show nuclei (round objects) and cardiac troponin I (line-like structures) (magnification x 600).
  • the distribution in beating frequency was evaluated by determining the beats per minute (bpm) of 109 different spontaneously contracting areas.
  • the average beating frequency was 44 bpm ⁇ 24 (Std.dev.).
  • the overall distribution is illustrated in Figure 3.
  • the culture medium can, at various time points during the experiments, be supplemented with different factors such as protein growth factors, chemical compounds, minerals, or other signalling molecules.
  • factors such as protein growth factors, chemical compounds, minerals, or other signalling molecules.
  • factors are BMP-2, BMP-4, BMP-5, TGF- ⁇ 1 , Activin A, bFGF, Growth hormone, LIF, and PDGF.
  • CMLC cardiomyocyte-like cell clusters
  • hBS cell line SA002 (Cellartis AB, G ⁇ teborg, Sweden, http://www.cellartis.com) was propagated as described Heins et al. 2004. This cell line is listed in the NIH stem cell registry and the UK Stem Cell bank. Differentiation of hBS cells was performed as described in Example 1 above. Using light microscopy clusters of spontaneously contracting cardiomyocyte-like cell clusters (CMLC) are frequently observed when hBS cells are differentiated through this protocol. For microarray experiments, three separate samples (biological replicates) of CMLC were collected.
  • CMLC cardiomyocyte-like cell clusters
  • CMLC 3 (pooled from passage 23-28, 32-34, 36-40, and 49)
  • the arrays were washed and then stained in a GeneChip® Fluidics Station 450. Scanning was carried out with the GeneChip® Scanner 3000 and image analysis was performed using GeneChip® Operating Software. SCIBLU - Sdorfe Centre for Integrative Biology at Lund University (http://www.lth.se/sciblu) conducted the quality controls, the RNA processing and the hybridization of the arrays. The samples representing undifferentiated hBS cells, differentiated contracting CMLC and a mixed population of differentiated cells were hybridized to the arrays. The arrays were run in duplicates.
  • the fold change (FC) in gene expression between undifferentiated hBS cells and the three different biological replicates of CMLC was calculated. Notably, in these calculations the amplified and the un- amplified RNA samples were kept separate. Genes that were called as Absent by the MAS software in all samples were filtered and not included in further analyses. In the amplified samples 17,436 probes were called as Absent in all samples and in the un-amplified samples 18,534 probes were called as Absent in all samples and these genes were filtered from the dataset.
  • FC-values had been calculated for each of the CMLC samples
  • the average of the FC-values (both amplified and un-amplified FC-values) were determined and subsequently used when filtering the genes.
  • Table I illustrates the distribution of up-regulated genes and summarizes the number of genes at specific FC levels (2, 3, 5, and 10).
  • a population of "mixed differentiated hBS cells” was included as control material to distinguish genes up regulated in all types of differentiated cells from genes specifically up regulated in cardiomyocyte-like cell clusters.
  • the "mixed differentiated hBS cells” thus represent a population of spontaneously differentiated hBS cells where cells from all three germ layers mesoderm, endoderm and ectoderm may be present.
  • FCCMLC Fold-change in gene expression between CMLC and undifferentiated hBS cells
  • FC M c FC in gene expression between the mixed differentiated hBS cells and undifferentiated hBS cells
  • the remaining 56 genes are listed in Table Il and these represent suitable marker genes for the CMLC.
  • the first group consists of genes previously associated with cardiac cells and the second of genes previously associated with endodermal cells, such as hepatocytes.
  • Examples of genes belonging to the first group are (marked in light grey in table II): MYH6, MYL7, MYL4, TNNC1 , TNNT2, PLN, TTN, MYH7, LDB3, NPPB, GATA6, MYL3, CSRP3, ACTN2, MB, MYOZ2, TBX5, and HSP27.
  • genes belonging to the second group are (marked in dark grey in table II): AFP, TF, APOA2, AHSG, SERPINA1 , APOA1, ALB, APOC3, TTR, APOB 1 and RBP4.
  • the selection shows an even distribution between endodermal and mesodermal genes expressed in the clusters.
  • the mesodermal genes and the endodermal are marked in, light grey and dark grey respectively in Table III.
  • RNA were pooled at various time points ( ⁇ 22 days) after the onset of contraction.
  • Undifferentiated hBS were harvested at day 4-5 after passage for RNA extraction or differentiated to obtain CMLC using cells in passage 23-41.
  • Spontaneously contracting clusters were identified by visual inspection using light microscopy and harvested by mechanical dissection. Specific care was taken only to harvest the beating areas with a minimum of surrounding non-contracting cells.
  • the material consisted of one pooled sample of undifferentiated hBS and two different biological replicates of pooled clusters.
  • the algorithm assigns a score to each gene based on differences in expression between conditions relative to the standard deviation of repeated measurements.
  • the false discovery rate (FDR) is determined by using permutations of the repeated measurements to estimate the percentage of genes identified by chance.
  • the algorithm was applied to each of the data sets from the two experiments separately using FDR ⁇ 0.04. Subsequently, only the genes marked as significantly up- or down-regulated in both data sets were considered as differentially expressed in CMLC compared to undifferentiated hBSs.
  • GO annotation terms shown in Figure 8 are associated with cardiomyocyte properties and functions.
  • about 10% of the up-regulated genes were annotated as "calcium ion binding" in the Molecular function category.
  • the results in the Biological process and Cellular component categories also support the presence of cardiac lineage in the hBSC-derived CMLC s.
  • the up-regulated genes are typically associated with processes such as "muscle contraction”, “cell differentiation”, and “development”.
  • the cellular component annotations have a predominance of "cytoskeletal compartments" and "myofibrillar structures” typical for the contractile apparatus active in cardiomyocytes.
  • STRING http://string.embl.de/
  • STRING a webserver to retrieve and display the repeatedly occurring neighbourhood of a gene.
  • STRING aims to collect, predict and unify various types of protein-protein associations, including direct (physical) and indirect (functional) associations.
  • 431 matches were made and potential interactions among products from these genes were investigated further.
  • a protein interaction map was created from these gene products and compared with protein interaction maps from 10 different randomly generated sets of genes, all of equal size. For each protein, an interaction score was calculated as n * 2/N, where n is the number of interactions (edges in the map) for the protein in question and N is the total number of input proteins. Furthermore, the number of hub proteins was determined. Following Han et al., we designated a protein as a hub if it had ⁇ 5 interactions with other proteins (Han JD, Berlin N 1 Hao T, et al. Evidence for dynamically organized modularity in the yeast protein-protein interaction network. Nature. 2004;430:88-93.
  • the protein interactions are substantially more complex between proteins coded by genes that are up-regulated in hBSC-derived CMLCs than what is observed in randomly generated sets of proteins of equal size.
  • considerably more hub proteins characterized by ⁇ 5 interactions with other proteins
  • Figure 10 In the interaction networks obtained from the randomly generated sets of genes, we typically observed a couple of smaller sub-networks that lacked interaction to each other.
  • Hedgehog signaling pathway also known to be critical in a plethora of developmental processes (Ingham et al 2006) is significantly up-regulated in the hBSC-derived CMLCs.
  • Sonic hedgehog appears to be a critical signaling factor for cardiac development in P19 cells (Gianakopoulos et al 2005).
  • experimental mice lacking hedgehog signaling show a delay in the expression of Nkx2.5 (Gianakopoulos et al 2005).
  • CMLC CMLC derived from undifferentiated hBS cells (SA002) (see Example 1 ).
  • the hBS were detached from the MEF feeder layer by incubation with collagenase IV (200 U/ml), for 10 - 15 minutes at 37 0 C.
  • the suspension was transferred to a 15 ml tube, and after the cells had sedimented, the supernatant was removed.
  • the colonies were re-suspended in culture medium and dissociated mechanically into small aggregates of undifferentiated cells using a pipette. This cell suspension was distributed (200 ⁇ l/well) into a 96 well plate (Costar, Coming, untreated, v-bottom) and centrifuged for 5 min at 400 x g.
  • CMLC clusters of cells
  • RNA from human adult normal heart tissue (pool from 6 different male donors) (BioChain®) was analyzed in parallel.
  • cDNA synthesis was performed using Superscript 3 (cat no 18080-051 Invitrogen). Each PCR reaction was run in quadruplicate. The relative gene expression levels were normalized against the expression of GAPDH and calculated according to the ⁇ Q- method.
  • the results from the PCR analysis are summarized in Figure 4.
  • the panel of genes is focused on ion channel expression which plays an important role in cardiomyocyte function.
  • drugs specific for a cardiac ion channel can be tested on CMLC.
  • Indicators such as action potential, beating frequency, and morphological appearance can be analyzed.
  • Cardiomyocyte-like cell clusters were derived from undifferentiated hBS cells as described in Example 1.
  • the clusters of spontaneously contracting cells were manually dissected and further divided into smaller clusters (about 0.2 - 0.3 mm in diameter).
  • the CMLC were vitrified in closed straws as described in Patent application "Vitrification" publication number WO2004 098285 and stored in liquid N 2 .
  • a sterile filtered vitrification solution including vitro-PBS (Vitrolife AB) supplemented with 10% ethyleneglycol and 10% DMSO was used, as well as vitro-PBS (Vitrolife AB) supplemented with 0.3 M trehalose, 20% ethyleneglycol and 20% DMSO.
  • the cells were recovered after thawing in culture medium (Knock Out DMEM supplemented with 20% FBS 1 1% penicillin-streptomycin, 1% Glutamax, 0.5 mmol/l ⁇ -mercaptoethanol, and 1% non-essential amino acids) and the results summarized below.
  • Colonies of undifferentiated hBS cells are separated from their feeder cells, using collagenase (200 U/ml, in DMEM/F12 medium). Colonies are collected either through passive sedimentation or via centrifugation. The colonies are then slightly broken up by gentle pipetting, and resuspended to give a final concentration of 4 average-sized colonies per 200 ⁇ l medium (Medium 1 ). Colonies are then centrifuged in a 96 well, v-bottom, uncoated plate (Corning article number: 3896) for 5 minutes at 400xg, with 200 ⁇ l (4 colonies) per well.
  • the plates are then stored in an humidified incubator at 37 0 C, with 5%CO 2 to allow 3D structures containing differentiated cells to form over a 3-8 day period. After this period, the 3D structures are transferred to gelatine coated Petri dishes and cultured for a period of two weeks in medium 2, below, with medium changes every two/three days.
  • CMLC clusters with contracting cells
  • Beat frequency average beats per minute 45.4 ⁇ 25.9 median beats per minute: 40
  • Width average 330 + 298 ⁇ m
  • median 260 ⁇ m
  • the distribution of beating frequency is affected by both the plating age of the 3D structures from which the cardiomyocytes-like cell clusters are obtained, and the culturing conditions after the plating of the 3D structures.
  • CMLC cardiomyocyte-like cell clusters
  • the clusters of spontaneously contracting cells were manually dissected and further divided into smaller clusters (about 0.2 - 0.3 mm in diameter).
  • the cell clusters were cryopreserved and in others the clusters were dissociated into single cell suspensions using trypsin/EDTA (15 min at 37°C).
  • the cell suspensions or cell clusters were transferred to cryopreservation media. The following different media compositions have been tested with comparable results regarding recovery of viable cells post-thawing:
  • Example 7 Use of cardiomyocyte-like cell clusters for in vitro pharmacological testing
  • Cardiomyocyte-like cell clusters were derived from undifferentiated hBS cells as described in Example 1 and cryopreserved as described in Example 4.
  • the CMLC were thawed and pharmacological test were performed using different platforms, such as micro- electrode arrays, voltage-clamp analysis, transmembrane action potential (TAP) measurements, and QT-screen system.
  • TAP transmembrane action potential
  • CMLC CM-derived and isolated from hBS cells as described in Example 1.
  • the CMLC were plated on microelectrode arrays (MEA). After adhesion of the CMLC to the MEA surface, the electrical activity was recorded as extracellular field potential by the substrate integrated electrodes of the MEA. Cardiac field potential properties have been studied before and their correlation with cardiac action potential data has been well described (Banach et al Am. J. Physiol. 2003, 284 (6): H2114 -H2123).
  • the addition of the QT-prolonging drug E-4031 causing hERG channel blockade was measured as a delayed repolarisation of the cardiac field potentials.
  • Example 9 Effect of combined treatment with Activin A and bFGF on cardiomyocyte- like cell clusters
  • CMLC were derived from undifferentiated hBS cells (cell line SA002, LOTAL002, passage 21 , 22, 44 and 51) essentially as described in Example 1.
  • the culture medium used before plating of the 3D structures was supplemented with Activin A (10 ng/ml) and bFGF (12 ng/ml).
  • the number of contracting CMLC was visually determined at day 6 or 7 after plating of formed 3D structures.
  • 3D structures were plated in CM medium supplemented with 2% FBS instead of 20% FBS.
  • the yield of contracting CMLC 7 days after plating was increased 2.5-fold by the combined pre-plating treatment with Activin A and bFGF (data not shown).
  • the effect of the treatment on beating area characteristics was determined in terms of distribution in beating frequency, length, width, calculated area and structure in two experiments; one using plating medium with 20% FBS and one with plating medium containing 2% FBS.
  • Example 10 Effects of medium composition, supplements, and plating day on CMLC formation from hBS cells.
  • Example 2 By modifying the basic protocol described in Example 1 it is possible to increase the yield of CMLC. In this example some of these opportunities are illustrated.
  • the serum component used has an effect on the yield of beating CMLC from hBS cells.
  • FBS as in Example 1
  • standard FBS as in Example 1
  • dialyzed FBS Invitrogen, art nr 26400-036
  • charcoal stripped FBS Invitrogen, art nr 12676-011 .
  • the cells were maintained in the presence of the different FBS (20%) during culture in the 96-well plates.
  • the aggregates formed were plated after 3 days in new dishes coated with gelatine and subsequent culture was done in the presence of standard FBS (20%).
  • the number of beating CMLC was determined 14 days after plating and the results are shown in Figure 13. The results indicate that there is a trend of increased yield by using the stripped FBS and by screening a large number of FBS batches it should be possible to identify an optimal batch.
  • hBS cells were differentiated in the absence or presence of Activin A and bFGF as described in Example 9.
  • the differentiated cells (3D-aggregates) were plated at day 7 in medium supplemented with 1000U/ml LIF. After 4 days the medium was changed to medium without LIF.
  • the number of beating CMLC was counted at day 7 and day 14 after plating and the results are shown in Figure 14.
  • treatment with Activin A and bFGF increased the yield of CMLC and the additional treatment with LIF further increased the generation of beating CMLC, especially at the early time point (7 days).
  • the day at which the 3D-aggregat.es are being plated after onset of differentiation also affect the yield of beating CMLC.
  • 3D-aggreates of differentiating hBS cells were generated as described in Example 1.
  • the 3D-aggregat.es were subsequently plated at day 7 (control) or earlier (day 3, 4, or 5) in new culture dishes.
  • the number of spontaneously beating CMLC was visually determined using a light microscope and the data are summarized in Figure 16. Plating earlier than day 7 significantly increases the final yield of CMLC.
  • TEP Transmembrane action potentials
  • the action potentials were recorded on a PC (sampling frequency 1 and 20 kHz) and the different action potential characteristics were analyzed using custom-designed software (Pharm-Lab v6.0b4, AstraZeneca) to determine AP duration at 50%, 70% and 90% of repolarization (dur50, dur70, dur90), AP amplitude (amp), membrane resting potential (MRP) 1 and maximum rate of rise of the AP upstroke (Vmax).
  • SPharm-Lab v6.0b4, AstraZeneca custom-designed software to determine AP duration at 50%, 70% and 90% of repolarization (dur50, dur70, dur90), AP amplitude (amp), membrane resting potential (MRP) 1 and maximum rate of rise of the AP upstroke (Vmax).
  • SPharm-Lab v6.0b4, AstraZeneca custom-designed software to determine AP duration at 50%, 70% and 90% of repolarization (dur50, dur70, dur90), AP amplitude (amp), membrane resting potential (MRP) 1
  • the bath was continuously perfused with Tyrode's solution consisting of (in mmol/L) 130 NaCI, 4 KCI, 0.5 MgSO4 « 7H20, 1.8 NaH2PO4xH2O, 18 NaHCO3, 5.5 glucose, 1.8 CaCI2 and kept at 37°C.
  • CMLC were derived from hBS cells as described in Example 1 and 9 and the clusters were grown on gelatine coated silicon pieces and on cover glasses, which allowed for easy transfer into the bath, and eliminated the problem of keeping the cluster at the same position. Electrical stimulation of the CMLC was done using field stimulation by means of a mobile electrode.
  • 0.5-1 ⁇ M E-4031 was used for testing the effect of blocking the rapid rectifier potassium current IKr. Change in APD was calculated and used to determine prolongation and assess triangularization.
  • results The cells were characterized as either nodal-like, atrial-like, or ventricle-like based on the results of transmembrane action potential (TAP) recordings.
  • TAP transmembrane action potential
  • the characteristics of action potentials recorded from beating CMLC are shown in Figure 17 and are summarized in the table below.
  • Data are ⁇ SD.
  • n indicates number of clusters of that type; bpm, beats per minute; RR, distance between APs, APD50/APD75/APD90, duration measured at 50%, 75%, or 90% repolarization; amp, AP amplitude; Vmax, maximum rate of depolarizing upstroke velocity.
  • Figure 18 shows a ventrical action potential with a dur 90 of 341ms and an amplitude of 97mV. Out of recordings from 145 different clusters, 24 showed APD(90) above 200ms.
  • cardiomyocytes respond to increased beating frequency by shortening of APD. This rate adaptation is fundamental and can be impaired in some diseases.
  • clusters were paced by means of electrical field stimulation and APD90 was compared at different frequencies.
  • Figure 20 shows that the APD90 is frequency dependent and that clusters with an initial APD90 over 180 ms displayed rate adaptation as pacing frequency increased (1-3Hz). Clusters with a short APD90 were only limitedly affected by a change in pacing frequency.
  • E-4031 which is a potent IKr blocker.
  • E-4031 induced concentration dependent action potential prolongation in all CMLC phenotypes as summarized in the table below. It also caused triangularization as an effect of the drug, triggered activity, and in some cases EADs were detected ( Figure 22 and 23).
  • 3D aggregate cultures were derived from undifferentiated hBS cells essentially as described in Example 1.
  • the cell line used for derivation was SA002, LOTAL002 (passage 25, 62 and 68).
  • the culture medium used before plating was supplemented with different combinations of 1 - 25 uM SB 216763 (GSK-3 inhibitor), 1 - 25 uM SKF-86002 (p38 MAP-kinase inhibitor) in addition to 1 - 20 ng/ml Activin A and 1.2 - 24 ng/ml bFGF. Three concentrations in each range were tested according to the scheme below.
  • CMLC The number of contracting CMLC was visually determined (Figure 24), and expression of the heart related genes Troponin T2, Nkx2.5 and GATA4 was measured by means of real-time RT quantitative PCR, at day 5 - 7 after plating of formed 3D structures. The experiment was repeated three times.
  • the combination of factors that produced the highest number of beating areas related to the amount of start material was 20 ng/ml Activin A 1 24 ng/ml bFGF, 25 ⁇ M SB 216763 and 1 ⁇ M SKF-86002 (group 4, Figure 24). However, other concentrations of these factors might also have an equal positive effect or be even more potent.
  • the gene expression of Troponin T2, Nkx2.5 and GAT A4 was closely related to the number of beating areas per colony (data not shown).
  • Example 13 lmmunohistochemical analysis of CMLC derived from hBS cells.
  • CMLC Spontaneously contracting CMLC were derived from undifferentiated hBS cells (SA002) essentially as described in Example 1.
  • the hBS cells were detached from the MEF feeder layer by incubation with collagenase IV (200 U/ml), for 10 - 15 minutes at 37 0 C.
  • the suspension was transferred to a 15 ml tube, and after the cells had sedimented, the supernatant was removed.
  • the colonies were re-suspended in culture medium and dissociated mechanically into small aggregates of undifferentiated cells using a pipette. This cell suspension was distributed (200 ⁇ l/well) into a 96 well plate (Costar, Corning, untreated, v-bottom) and centrifuged for 5 min at 400 x g.
  • CMLC spontaneously contracting clusters of cells
  • CMLC clusters were analysed for each marker and the results were consistent across all the samples. All antibodies were diluted as fallows: rabbit monoclonal anti cardiac Troponin I (Abeam, ab52862) 1 :250, mouse-lgG2b anti Oct-3/4 (Santa Cruz, SC-5279) 1 :500, mouse-lgG3 anti SSEA-4 (Santa Cruz, SC-21704) 1 :200, and mouse-lgM anti TRA-1-60 (Santa Cruz, SC-21705) 1:200.
  • DAKO DakoCytomation Fluorescent Mounting Medium
  • Example 14 The effect of Zatebradine on CMLC.
  • CMLC were derived from undifferentiated hBS cells essentially as described in Example 1 using cell line SA002.
  • Zatebradine is a substance known to block so called funny channels, e.i. hyperpolarization-activated, cyclic nucleotide-gated (HCN) channels 1-4, which are involved in the regulation of cardiomyocyte contraction and cardiac rate.
  • HTN hyperpolarization-activated, cyclic nucleotide-gated
  • HCN4 is the one most highly expressed in the sinoatrial node and is therefore considered the most important in generating and determining pacemaker activity.
  • the gene expression of HCN4, as well as Troponin T2 was positively correlated to the beating frequency, i.e. the more HCN4 or Troponin T2 expression the higher contraction rate ( Figure 28).
  • the expression of HCN4 decreased with the age of the hES-CMC ( Figure 28), while there was no correlation between Troponin T2 and age (data not shown).
  • the gene expression of HCN4 was positively related to the Troponin T2 expression (data not shown).
  • Example 15. lmmunohistochemical analysis of CMLC derived from hBS cells.
  • CMLC clusters were prepared and used for immunohistochemcial analysis as described in Example 13. Nuclei were visualized using blue-fluorescent 4',6-diamindino-2- phenylindole (DAPI). The primary antibodies used were: rabbit polyclonal anti KCNH2 (Abeam, ab32585) and rabbit monoclonal anti cardiac Troponin I (Abeam, ab52862). The results are shown in Figure 29 and positive staining was obtained using the anti-hERG (KCNH2) antibody in areas of the CMLC clusters that co-express the specific cardiac cell marker cardiac Troponin I (cTnl).
  • noradrenaline and adrenaline Apoteket, Umea, Sweden
  • phenylephrine and forskolin Sigma Chemicals, St. Louis, Mo 1 USA
  • phenoxybenzamine and acetylcholine KeLab, Goteborg, Sweden
  • atenolol and atropin NM Pharma AB, Taby, Sweden
  • labetalol Gaxo Smith Kline, M ⁇ lndal, Sweden
  • verapamil (Abbot Scandinavia AB, Solna, Sweden).
  • Phenylephrine an ⁇ 1 -adrenoceptor agonist
  • Contractile activity is stimulated in a dose-dependent manner (see Table 1 in Norstr ⁇ m et al.). The stimulatory effect is more pronounced in specimens with low basal contraction frequency. It is noted how many beating areas that are non-responsive to phenylephrine. Phenylephrine (10-7 M), administered to arrested areas, initiates contractile activity promptly. The stimulatory effect of phenylephrine is counteracted by phenoxybenzamine, a blocker of ⁇ 1 -and ⁇ 2- receptors.
  • Irregular contractions can occasionally be observed at maximal stimulation by phenylephrine but normally returns to regular beats following inhibition by phenoxybenzamine. If primarily administrated to contracting clusters of cells, phenoxybenzamine, is expected to reduce the contraction frequency. This effect is immediate and may be followed by a successive restitution of contraction frequency. The inhibition can be reversed by phenylephrine.
  • Adrenaline exhibiting predominantly ⁇ 1 -adrenoceptor agonistic effects in the myocardium, can be used to test stimulated contractile activity.
  • the stimulatory effect is registered within minutes and maximal stimulation occurs at a certain. In specimens exhibiting low contraction frequency ( ⁇ 20bpm) an increase of frequency may be observed at certain concentrations.
  • the stimulatory effect is reduced within minutes following administration of atenolol, a ⁇ - receptor blocker.
  • labetolol, a ⁇ - and ⁇ 1 -receptor blocker can be used to show a reduction in the stimulation of contraction frequency exerted by adrenaline. Atenolol (10-7 M), may reduced spontaneous contractile activity within 2 min.
  • Noradrenaline an ⁇ - and ⁇ 1- adrenoceptor agonist, stimulates contractile activity normally in a concentration-response manner. Maximal stimulation is reached within 10 min and this response can be reversed by phenoxybenzamine. Noradrenaline (10-7 M) administered to an arrested cell can initiate contractile activity within minutes.
  • Acetylcholine exerting muscarinic effect in the myocardium, reduces the contractile activity. Following administration of 10-4-10-3 M acetylcholine total inhibition may be observed and it may persist for hours.
  • Atropin which competes with acetylcholine for a common binding site on the muscarinic receptor, counteracts the inhibition by acetylcholine.
  • atropin (10-6 M) stimulates spontaneous contractile activity.
  • Verapamil a blocker of the trans-membranous flow of Ca2+ ions and inhibitor of mobilization of intracellular Ca 2+, reduces or abolishes the contractile activity, depending on the concentration primarily administered.
  • Spontaneous contractions of basal frequency can be reestablished following washing and exchange of medium within 30 min.
  • Forskolin is generally recognized as a stimulator of adenylate-cyclase and formation of cyclic adenosine monophosphate (cAMP).
  • a stimulatory response may be registered after 30 min of treatment with 10-10-10-6 M of forskolin as compared with baseline frequency.
  • Two beating areas are exposed to pico-molar concentrations of forskolin. In these areas the contractile activity may be inhibited at 10-12 M during registration between 5 and 30 min but stimulated at higher concentrations of forskolin, though an initial but transient inhibition may be observed 5 min after administration.
  • contracting clusters did not respond to any chronotropic agent which may imply an impediment of receptor differentiation. It has previously been shown that the response to adrenoceptor agonists is time-dependent and better recognized in more differentiated cardiomyocytes (4).
  • Reubinoff BE Pera MF, Fong CY, Trounson A 1 Bongso A., Embryonic stem cell lines from human blastocysts: somatic differentiation in vitro., Nat Biotechnol. 2000 Apr; 18(4):399-404. Erratum in: Nat Biotechnol 2000 May; 18(5):559.
  • a cluster comprising cardiomyocyte-like cells, the cluster comprising genes that are up- regulated and have, i) expression values of 500 or more, ii) a fold change in gene expression between cardiomyocyte-like cells and undifferentiated hBS cells (FC CMLC ) of 10 or more.
  • a cluster according to items 1 and 2 the cluster comprising genes that are up-regulated further have, iii) a ratio between FC CMLC and FC M c (i- ⁇ - the fold change between mixed differentiated hBS cells and undifferentiated hBS cells) of 10 or more.
  • a cluster according to any of the preceding items derived from BS cells such as, e.g., hBS cells.
  • derived BS cells are trisomic hBS cells carrying an extra chromosome 13, such as SA002 carrying an extra chromosome 13.
  • a cluster according to any of the preceding items containing from about 10 to about 5000 cells.
  • said expression value of the up- regulated genes is about 750 or more such as, e.g., an expression value of about 1000 or more, about 1500 or more, about 2000 or more, about 2500 or more or about 3000 or more.
  • FC( CMLC ) value of the up- regulated genes is about 20 or more such as, e.g., about 50 or more, about 100 or more, about 500 or more, about 750 or more, about 1000 or more.
  • said ratio of FC CMLC /FC MC of the up-regulated genes is about 15 or more such as, e.g., about 20 or more, about 50 or more, about 100 or more, about 500 or more, about 750 or more, about 1000 or more.
  • a cluster according to any of the preceding items, wherein 2 or more such as, e.g., 4 or more, 6 or more, 8 or more, 10 or more, 12 or more or 16 or more of the up-regulated genes are genes associated with cardiac cells (described in Table Il herein).
  • a cluster according to any of the preceding items, wherein 2 or more such as, e.g., 4 or more, 6 or more, 8 or more of the up-regulated genes are genes associated with endodermal cells (described in Table Il herein).
  • a cluster according to any of the preceding items, wherein 2 or more such as, e.g., 4 or more, 6 or more, 8 or more of the up-regulated genes are genes associated with non cardiac or non endodermal cells, described in Table Il herein.
  • up-regulated genes comprise 10 or more such as, e.g., 20 or more, 30 or more, 40 or more, 50 or more, 55 or more or all genes listed in Table Il herein.
  • a cluster according to any of the preceding items wherein the cluster comprising genes that are up-regulated and have, i) expression values of 2000 or more, ii) a FCc ML c value of 100 or more.
  • said expression value of the up-regulated genes is about 2500 or more such as, e.g., an expression value of about 3000 or more, about 3500 or more, about 4000 or more, about 4500 or more, about 5000 or more, about 5500 or more, about 6000 or more, about 6500 or more, or about 7000 or more.
  • FC( CMLC ) value of the up-regulated genes is about 200 or more such as, e.g., about 400 or more, about 600 or more, about 800 or more, about 1000 or more, about 2000 or more.
  • up-regulated genes comprise 2 or more such as, e.g., 4 or more, or 6 or more, 8 or more or all genes listed in Table III herein.
  • the ion channel is a K- or Na-voltage-gated channel, K- or Na-ligand-gated channel, a K-inwardly-rectifying channel and/or a Ca-voltage- dependent channel.
  • a cluster according to item 30 expressing at least 3 such as, e.g., at least 4, at least 5 or all of the ion channels listed in Figure 7 a and b, poster Table 1.
  • a composition of cardiomyocyte-like clusters according to item 37, wherein the ratio between the number of clusters containing nodal-like cells and the number of clusters containing ventricle-like cells is in a range of from about 1 :100 to about 80:100 such as from about 10:100 to about 70:100, from about 30:100 to about 70:100, from about 45:100 to about 55:100 or about 50:100.
  • composition comprising one or more clusters as defined in any of items 1-33 and a carrier.
  • composition according to item 42 wherein the carrier is an aqueous medium.
  • composition according to item 45 wherein the additive is one or more cryoprotectants, one or more stabilizers and/or one or more viscosity-adjusting agents.
  • cryoprotectants is selected from the group consisting of ethylene glycol, propylene glycol, dimethylsulfoxide, glycerol, propanediol, and methyl pentanediol, and or mixtures thereof.
  • a composition according to item 51 wherein the concentration of sucrose is from about 0.02 M to about 1 M, such as, e.g., from about 0.05 M to about 0.9 M, from about 0.1 M to about 0.8 M, from about 0.15 M to about 0.7 M, from about 0.2 M to about 0.65 M, from about 0.25 M to about 0.6 M.
  • composition according to any of items 34-53 wherein the concentration of DMSO is at least 2.5 % v/v, such as e.g. from about 2.5% to about 40% v/v, from about 5% to about 35% v/v, from about 7% to about 30% v/v, from about 7% to about 25% v/v, from about 7% to about 20% v/v, from about 15% to about 25% v/v, or from about 5% to about 15% v/v.
  • concentration of DMSO is at least 2.5 % v/v, such as e.g. from about 2.5% to about 40% v/v, from about 5% to about 35% v/v, from about 7% to about 30% v/v, from about 7% to about 25% v/v, from about 7% to about 20% v/v, from about 15% to about 25% v/v, or from about 5% to about 15% v/v.
  • 60. A composition according to any of items 34-59, wherein the one or more clusters retain at least 95% of its characteristics as defined in any of items 1-33 after storage of the composition at a temperature of at least -80 0 C for at least 2 years.
  • kits for use in testing of cardiotoxicity of a specific substance comprising i) one or more clusters as defined in any of items 1-33 or a composition as defined in any of items 34-61 , ii) specific instructions for use of the cluster or composition, whichever is relevant.
  • a kit according to item 62 further comprising iii) a medium into which the specific substance is dispersed before use of the kit.
  • kits according to any of items 62 or 63 comprising a composition as defined in any of items 34-61.
  • kits for use in in vitro testing during drug discovery of a specific substance comprising i) one or more clusters as defined in any of items 1-33 or a composition as defined in any of items 34-61 , ii) specific instructions for use of the cluster or composition, whichever is relevant.
  • a kit according to item 65 further comprising iii) a medium into which the specific substance is dispersed before use of the kit.
  • kits according to any of items 65 or 66 comprising a composition as defined in any of items 34-61.
  • a kit for regenerative medicine comprising i) a composition as defined in any of items 34-61 and/or one or more cardiomyocyte-like cell clusters as defined in any of items 1-33, ii) tools for administration of the composition or the cells to a patient such as, e.g., the cells in an administrative form, such as in a ready-to-use syringe.
  • kits according to item 68 comprising a composition as defined in any of items 34-61.
  • a method for obtaining one or more clusters according to items 1-33, comprising 3D formation of differentiating hBS cells in a medium supplemented with one or more members from the transforming growth factor beta superfamily and/or one or more members from the fibroblast growth factor family.
  • a method for obtaining the clusters according to items 1-33 comprising the steps of,
  • a method according to any of items 71-73, wherein the dissociation in step 3) is performed manually.
  • 75. A method according to any of items 72-74, wherein the centrifugation is performed at 100-800 x g for 2-20 minutes, such as e.g. at 200-600 x g for 5-10 minutes, or 300-500 x g for 5-10 minutes, or at 400 x g for 5 minutes.
  • a method according to any of items 71-78, wherein the development in step 5) of item 71 and/or step 7) of item 72 are for 1-30 days, such as e.g. 1-15 days, 1-10 days, or 1-5 days, until the formation of cardiomyocyte-like cell clusters.
  • a method according to any of items 72-79, wherein the medium used in step 5) and/or 7) of item 72 comprises 15-25% of FBS, such as e.g. 20% FBS.
  • a method according to any of items 71-80, wherein the medium used in step 2) of item 71 and/or step 5 and/or 7) of item 72 comprises a member from the transforming growth factor beta superfamily and/or a member from the fibroblast growth factor family.
  • a method according to item 81 wherein the member from the transforming growth factor beta superfamily is Activin A and the member from the fibroblast growth factor family is bFGF.
  • a method according to item 82, wherein the concentration of Activin A supplemented to the culture medium is about 5-40 ng/ml, such as e.g. 8 ng/ml, 9 ng/ml, 10 ng/ml, 11 ng/ml, or 12 ng/ml.
  • a method according to any of items 72-85, wherein the medium used in step 5 and/or 7) of item 72 comprises a member of GSK-3 inhibitors and/or p38 MAP kinase inhibitors.
  • a method according to any of items 71-89, wherein medium used in step 5) of item 71 and/or step 7) of item 72 comprises between 100-2000 U/ml LIF, such as e.g. between 500- 1500 U/ml, or 1000 U/ml.
  • a method according to item 90 wherein the medium comprising LIF is replaced after 2-8 days of incubation, such as after e.g. 4-5 days, with a medium without LIF.

Abstract

L'invention porte sur un agrégat comportant des cellules de type cardiomyocyte, l'agrégat présentant i) des cellules contractiles, b) des cellules qui sont électriquement connectées, et exprimant iii) des marqueurs cardiaques comprenant Nkx.2.5, la troponine et la myosine, iv) des marqueurs pour des récepteurs adrénergiques fonctionnels, v) des marqueurs pour des récepteurs muscariniques fonctionnels, vi) des marqueurs pour des canaux ioniques fonctionnels comprenant les canaux hERG, Na+, Ca2+ et K+, vii) un ou plusieurs marqueurs endodermiques sélectionnés dans le groupe constitué par AFP, TF, APOA2, AHSG, SERPINA1, APOA1, APOC3, TTR1, APOB et RBP4. L'invention porte sur un procédé de préparation des agrégats et sur leur utilisation dans la découverte de médicaments et dans les essais de toxicité par criblage.
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AU2008300897A AU2008300897B2 (en) 2007-07-18 2008-09-18 Cardiomyocyte-like cell clusters derived from hBS cells
US12/678,825 US20100278787A1 (en) 2007-07-18 2008-09-18 Cardiomyocyte-like cell clusters derived from hbs cells
JP2010525254A JP5722628B2 (ja) 2007-07-18 2008-09-18 ｈＢＳ細胞由来の心筋細胞様細胞クラスター
CN200880116644XA CN101918541A (zh) 2007-07-18 2008-09-18 衍生自hBS细胞的心肌细胞样细胞簇

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AU2008300897A1 (en) 2009-03-26
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